Consulting Service: Webinar Series. Overview of Research in Arts in Healthcare

Transcription

1 Consulting Service: Webinar Series Overview of Research in Arts in Healthcare Presented by Upali Nanda and Jill Sonke The Society is grateful to the National Endowment of the Arts for its support of the Consulting Service, which strives to provide affordable assistance to organizations wishing to establish or advance the arts in healthcare.

2 Presenters Jill Sonke Director, University of Florida, Center for the Arts in Healthcare; Asst. Director, Shands Arts in Medicine Upali Nanda VP, Director of Research, American Art Resources

3 Road Map Section I Building blocks of research Design, method, IRB, protocol, etc. Examples and resources Section II Examples of research/state of the Field Report Funding

4 Society for the Arts in Healthcare SECTION I: Building Blocks of Research By Upali Nanda, PhD, Assoc.AIA, EDAC VP, Director of Research American Art Resources

5 Pressing Concerns in Research Research SIG Online survey (35 responses): Most Pressing Challenges for Research in Healthcare Arts Today: 1. Availability of funding sources 2. Availability of research training (specific to the healthcare arts)

6 Pressing Concerns in Research Most Important Resources Needed to Conduct Research in the Healthcare Arts Today: 1. Information on funding sources 2. Online repository for research articles 3. A research primer with clear terminology, overview of methods, and case studies

7 Research Primer Research on the Effect of the Arts on Health Re search noun Diligent and systematic inquiry or investigation into a subject in order to discover or revise facts, theories, applications, etc. (

8 Theory A theory is a system, model, or framework of statements that describes and explains natural or social phenomena, which is logically consistent and cohesive by itself. A theory is not directly observable by itself but should be able to predict or explain certain phenomena. Hypotheses are predictions that are logically derived from theories and can be tested in empirical research.

9 Theory Healing Arts Therapeutic Environments A theory is a system, model, or framework of statements that describes and explains natural or social phenomena, which is logically consistent and cohesive by itself. A theory is not directly observable by itself but should be able to predict or explain certain phenomena. Listening to music can reduce anxiety. Nature views reduce stress. Hypotheses are predictions that are logically derived from theories and can be tested in empirical research.

10 Early Decisions Who: Population sample Where: Research site Why and how: Research design

11 Research Questions Descriptive: When a study is designed primarily to describe what is going on or what exists Relational: When a study is designed to look at the relationships between two or more variables Causal: When a study is designed to determine whether one or more variables (e.g., a program or treatment variable) causes or affects one or more outcome variables Source:

12 Research Questions Descriptive Relational Causal What kind of art do patients like? Do patients prefer art with specific visual elements? Does viewing a landscape image with a high depth of field reduce stress?

13 The Two Approaches in Research Qualitative "All research ultimately has a qualitative grounding" - Donald Campbell The aim is a complete, detailed description. Researcher may only know roughly in advance what he/she is looking for. Recommended during earlier phases of research projects. The design emerges as the study unfolds. Researcher is the data gathering instrument. Data is in the form of words, pictures or objects. Subjective - individuals interpretation of events is important,e.g., uses participant observation, in-depth interviews etc. Quantitative "There's no such thing as qualitative data. Everything is either 1 or 0" - Fred Kerlinger The aim is to classify features, count them, and construct statistical models in an attempt to explain what is observed. Researcher knows clearly in advance what he/she is looking for. Recommended during latter phases of research projects. All aspects of the study are carefully designed before data is collected. Researcher uses tools, such as questionnaires or equipment to collect numerical data. Data is in the form of numbers and statistics. Objective seeks precise measurement & analysis of target concepts, e.g., uses surveys, questionnaires etc. Qualitative data is more 'rich', time consuming, and less able to be generalized. Quantitative data is more efficient, able to test hypotheses, but may miss contextual detail. Researcher tends to become subjectively immersed RESEARCH in Researcher WEBINAR tends to remain objectively separated from the subject matter. THE SOCIETY SOCIETY FOR OF THE ARTS the FOR IN subject HEALTHCARE matter.

14 RESEARCH METRICS: OUTCOMES The following table illustrates the different kinds of health outcomes and relevant research measures 1 : CLINICAL INDICATORS PATIENT/STAFF/ FAMILY BASED OUTCOMES ECONOMIC OUTCOMES Description Observable signs and symptoms relating to the patients health conditions Patient satisfaction with healthcare services and staff satisfaction with working conditions. Such as cost of patient care, staff turnover, philanthropy to the hospital etc. Outcome Measure Length of hospital stay, blood pressure, intake of pain medication, Heart rate, Skin conductance etc. Patient ratings of perceived pain and anxiety, Staff rating of working conditions and satisfaction etc. Cost of patient care, Staff turnover, Philanthropy to the hospital etc., Patient Enrollment, Renovation Needs. Instrument Medical Equipment and personnel for collection of Data Statistical tools for analysis Questionnaires, Surveys, Interviews. Existing Hospital records Financial records by design firm Example Patients with a view of nature requested significantly fewer doses of analgesics in the period between two and five days after surgery and spent a shorter time in the hospital than those with a view of a brick wall Adult patients in a procedure room reported better pain control when exposed to a nature scene with nature sound in the ceiling 2 Patients with a view of nature spent a shorter time in the hospital than those with a view of a brick wall resulting in a $500 lower cost per case 3 1 Adapted from: Ulrich R. and Gilpin, L. (2003). Healing Arts. In Frampton, S., Gilpin, L, and Charmel P.A., (eds). Putting Patients First. 2 Diette, G. B., Lechtzin, N., Haponik, E., Devrotes, A., & Rubin, H. R. (2003). Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: A complementary approach to routine analgesia. Chest, 123(3), Ulrich, R.S. (1984). View Through a Window May Influence Recovery from Surgery. Science

15 Example: View from Window, Ulrich (1984) Population: Hospital patients Sample: Inpatients recovering from gallbladder surgery Hypothesis: View impacts recovery Study design: Retrospective Studying medical records of patients with similar medical conditions and medical care in identical units differing only in the view from the window Analysis: Statistical analysis correlating different parameters Findings: Nature view resulted in lower LOS, lesser analgesics, and more positive notes

16 Research Process Partnering with hospital Research idea Lit review, theoretical basis Developing a hypothesis Creating a research design Target population Scope Survey instrument Drafting research protocol for IRB submission Collecting data Analyzing data Publishing and presenting

17 Time Allocation RESEARCH DESIGN DATA COLLECTION ANALYSIS AND PUBLICATION PROCURING FUNDING AND OTHER RESOURCES

18 Setting Up a Collaborative Team ARTIST/ FACILITATOR HOSPITAL ADMIN AND/OR RESEARCH STAFF RESEARCH DESIGN RESEARCHER (IN-HOUSE/ CONSULTANT/ ACADEMIC PARTNER)

19 Drafting the Research Protocol The research protocol is a formal design for research involving human subjects or research animals that an investigator submits to an Institutional Review Board (IRB) or an Institutional Animal Care and Use Committee (IACUC) for review. A protocol generally has an objective, a rationale, a design, eligibility requirements, a description of research and data analysis methods. Protocols must conform to stringent federal regulations.

20 Research Compliance INSTITUTIONAL REVIEW BOARD (IRB) An institutional review board (IRB), also known as an independent ethics committee (IEC) or ethical review board (ERB), is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans with the alleged aim to protect the rights and welfare of the research subjects.

21 IRB Review Full Review Expedited Review IRB Exempt

22 Figuring out IRB Issues /humansubjects/guidanc e/decisioncharts.htm whether an activity is research that must be reviewed by an IRB whether the review may be performed by expedited procedures whether informed consent or its documentation may be waived

23 IRB Exemption

24 From Research to Evaluation The main difference between research and evaluation is that research is usually conducted with the intent to generalize the findings from a sample to a larger population. Evaluation, on the other hand, usually focuses on an internal situation, such as collecting data about specific programs, with no intent to generalize the results to other settings and situations. In other words, research generalizes, evaluation particularizes. arch&evaluation.html

25 Available Resources Society website Journal: Arts & Health: An International Journal for Research, Policy and Practice Research Directory: View a current directory of arts in healthcare research. Members have the additional benefit of posting their research to this directory. Conference Proceedings: View proceedings from recent Society for the Arts in Healthcare Annual Conferences. Online databases : For example, Google Scholar, Pubmed, and J- Stor Local libraries/university databases Listservs: For example, SAH Research Special Interest Group

26 Society for the Arts in Healthcare SECTION II: Research Examples and Funding Opportunities By Jill Sonke, MA Director, Center for the Arts in Healthcare, University of Florida Assistant Director, Shands Arts in Medicine

27 State of the Field Report

28 State of the Field Report In today s healthcare world, with approximately 30% of all healthcare spending going toward ineffective, redundant, or inappropriate care; capital resources scarce; the economy sagging; and the cost of healthcare becoming a hot political issue, healthcare decision-makers are demanding that decisions be based on evidence (Hayes, 2008).

29 State of the Field Report Benefits of the Arts in Healthcare: A Sampling of Research Findings Methods used to measure benefits Music Visual arts Effects of images Design implications Dance Literature, creative writing, and storytelling Drama Health promotion and injury prevention Theory Economic benefits

30 Staricoff (2004) Reviewed 385 arts in healthcare studies published between 1990 and 2004 Presents evidence defining the outcomes that have been achieved through the application of the arts in healthcare settings Concluded that the arts were found to contribute to physiological and psychological changes in clinical outcomes; reductions in drug consumption and length of hospital stays; increases in job satisfaction among staff; better doctor-patient relationships; improved mental health; development of health practitioners empathy across gender and cultural diversity.

31 Other useful meta-analyses Bygren, Konlaan, and Johanssen (1996) conducted a nine-year study of 15,198 individuals to determine the health and life-extending implications of attending cultural events, such as performances and art exhibits; controlled for eight confounding variables: age, sex, education level, income, long term disease, social network, smoking, and physical exercise; found that people who regularly attend cultural events live longer. This outcome was attributed not to better health among those with higher incomes but to the effect of engagement in the arts in stimulating the immune system.

32 Other useful meta-analyses Bygren et al. (2001) study designed to assess how changes in the habit of attending cultural events might predict self-reported health sample of 3,793 adults over an eight-year period controlled for type of residence, geographical region of domicile, and socio-economic status (level of education) found a 65% increase in the risk of impaired perceived health among those who were not culturally active as compared with those who were culturally active

33 Other useful meta-analyses Matarasso (1997) Meta-analysis of over 50 studies of the health impact of the arts showed significant benefits for both individual and societal health. Concluded that participation in the arts can have a positive impact on how people feel; be an effective means of health education; contribute to a more relaxed atmosphere in health centers; help improve the quality of life of people with poor health; provide a unique and deep source of enjoyment.

34 Funding Opportunities: Federal (USA) National Institutes of Health (NIH), including NIA: List of federal agencies: index.shtml US Department of Commerce US Department of Defense

35 Funding Opportunities Research and other foundations look at foundations dedicated to your targeted patient population/subjects. Society for the Arts in Healthcare Research Grant (American Art Resources & Society for the Arts in Healthcare Environmental Arts Research Grant : $1000)

36 Thank you. SOCIETY FOR THE ARTS IN HEALTHCARE